高安動脈炎による急性心筋梗塞：冠動脈画像および生理機能ガイド下の管理

Myocardial infarction (MI) in young women may result from vasospasm, spontaneous coronary artery dissection, vasculitis, or plaque rupture. These etiologies are not always distinguishable on coronary angiography alone, necessitating additional intravascular imaging.

A 25-year-old woman presented with non-ST segment elevation MI and was found to have proximal left anterior descending artery occlusion. Intravascular ultrasound (IVUS) revealed features suggestive of Takayasu arteritis, which was confirmed through further work-up. Based on IVUS and fractional flow reserve (FFR) findings, stenting was deferred. She was started on immunosuppressive therapy and remained asymptomatic at 2-month follow-up.

Multimodality assessment using IVUS together with physiologic evaluation by FFR was critical in identifying vasculitic changes and guiding a conservative interventional strategy. Long-term management focused on immunosuppression to control disease activity.

In young women with MI, nonatherosclerotic causes should be considered. IVUS and FFR can aid diagnosis and help avoid unnecessary coronary intervention.